<!DOCTYPE html>
<html>
<head>
<meta charset="ISO-8859-1">
<title>Help Desk Request</title>

<style type="text/css">
  body{
  background-color: lightblue;
}
</style>

</head>
<body>
<strong>Help Desk Request</strong><br><br>
<form action="request" method="post">
<table>
<tr>
<td>User Name:</td>
<td><input type="text" name="userName"></td>
</tr>
<tr>
<td>User Department:</td>
<td><input type="text" name="userDept"></td>
</tr>
<tr>
<td>Type Of Request:</td>
<td><select name="problem">
<option>Select</option>
<option>Software(new install or upgrade)</option>
<option>Hardware(repair or upgrade)</option>
<option>Account assistance(new account needed or login problem)</option>
</select></td>
</tr>
</table>

Request Description:<br>
<textarea rows="5" cols="50" placeholder="Your text here..." name="desc"></textarea><br>

Urgency:<br>

<input type="radio" name="urgency" value="Urgent">Urgent(0 - 4 hours completion)<br>
<input type="radio" name="urgency" value="High">High(1 - 2 days completion)<br>
<input type="radio" name="urgency" value="Medium">Medium(3 - 5 days completion)<br>
<input type="radio" name="urgency" value="Low">Low(6+ days completion)<br>
<input type="radio" name="urgency" value="No Hurry">No Hurry<br><br>

<input type="reset" value="Clear">
<input type="submit" value="Submit">
</form>
</body>
</html>